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Reconstruction
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Nadir I. Osman, Karl H. Pang, Christopher R. Chapple
Flaps elevation and methods of transfer:Peninsular flap: vascular and cutaneous connections are left intact.Advancement flaps − the graft is moved parallel to the pedicle.Rotational flaps − the graft is moved at a right angle to the long axis of pedicle.Island flap: skin is divided, but the vascular connections are maintained.Free flap: tissue + vessels are detached from the donor site and anastomosed to the vessels at the recipient site.
Spinal Injuries
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Hyperflexion injuries are typically caused by flexion about an axis anterior to the vertebral bodies. Hyperflexion injuries are seen more commonly in RTCs where lap-type seat belts are used rather than three-point seat belts. Other causes of flexion injuries include rapid deceleration in the flexed position, falls on the back of the head with flexion of the neck, diving and contact sports such as rugby. Anterior column compression and, more importantly, posterior ligamentous complex distraction occur. The typical bony lesion associated with this mechanism is a horizontal fracture extending through the body, pedicle and posterior elements of the vertebra (‘Chance fracture’). Pure hyperflexion injuries in the cervical vertebrae are less common because flexion is limited by the chin abutting the chest. Extreme cervical hyperflexion can fracture the anterior superior corner of the inferior vertebrae (teardrop fracture) and rupture the posterior ligaments. This unstable injury is usually found in the C5/6 region. The odontoid peg of C2 may also be fractured by sudden severe flexion.
Applied Surgical Anatomy
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Vishal G Shelat, Andrew Clayton Lee, Julian Wong, Karen Randhawa, CJ Shukla, Choon Sheong Seow, Tjun Tang
What are the broad types of tissue flaps that you can raise? Give a description.Random skin flap: A tissue flap consisting of the full thickness of the skin and subcutaneous tissue. The flap is connected by skin bridge to the surrounding skin.Pedicle flap: A tissue flap consisting of the full thickness of the skin, subcutaneous tissue with or without underlying muscles. The flap is attached to the body by a vascular pedicle.
Development of a flexible instrumented lumbar spine finite element model and comparison with in-vitro experiments
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Aleksander Leszczynski, Frank Meyer, Yann-Philippe Charles, Caroline Deck, Rémy Willinger
For the instrumented lumbo-pelvic FEMs, three different configurations of L2-Pelvis instrumentation were developed according to in-vitro experiments of Godzik et al. (2019): bilateral single rod (Config1), single rod with an interbody cage at L5-S1 (Config2) and bilateral double rods with interbody cage at L5-S1 (Config3). The configurations are shown in Figure 4 and are described below. Pedicle screws, connectors, rods and interbody cages were meshed with hexahedral elements. Pedicle screws were centered in the pedicles along the anatomical axis and penetrated the vertebral body. The two main rods (diameter 5.5 mm) were adapted to the profile of the spine; passing through the screw head centers. Double rods were positioned medially with a distance of 7.5 mm and connected to the main rods by side-to-side connectors between L3-4 and S1-ilium. Anterior lumbar interbody fusion (ALIF) cages were modeled using the L5-S1 NP mesh. The assumption was made that pedicle screws were rigidly fixed to the vertebrae and to the rods, thus restraining relative movements.
Vaginal Stenosis After Cervical Cancer Treatments: Challenges for Reconstructive Surgery
Published in Journal of Investigative Surgery, 2021
Antonio Simone Laganà, Simone Garzon, Ricciarda Raffaelli, Helena Ban Frangež, David Lukanovič, Massimo Franchi
A neovagina reconstruction can be the only option when the vaginal stenosis is severe. Nevertheless, although different techniques have been developed and proposed for neovagina reconstruction in case of vaginal congenital atresia or male-to-female transition [7], the reconstruction of neovagina in women underwent radiotherapy with vaginal stenosis is more challenging because the radiotherapy causes a fibrosis of the pelvic tissue with compromised vascularization and reduced elasticity [8]. Therefore, techniques based on vascular pedicles were usually recommended in these patients, although series of neovagina reconstruction using a skin graft were reported [8]. The adoption of a graft with vascular pedicle is usually favored because it allows the transposition in the fibrotic pelvis of a healthy tissue with appropriate vascularization that should favor healing and reduce complications [9]. In this scenario, the recently published study “Use of vaginal reconstructive surgery in cervical cancer patients to prevent vaginal stump contracture” highlights the role of the ileal graft with vascular pedicle as a technique able to reconstruct the vagina in case of severe vaginal stenosis after treatments for cervical cancer [10].
Immediate fat and nanofat-enriched fat grafting in breast reduction for scar management
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Cemal Alper Kemaloğlu, İrfan Özyazgan, Zeynep Burçin Gönen
Patients were operated on by one of two surgeons (C. A. K. and İ. Ö.). The pre-operative markings were made when the patients were in the standing position. The new nipple position was created at the IMF level, which was approximately 21 cm away from the sternal notch. Then, markings were made according to an inverted T-scar pattern. The vertical length of the T-scar, from the nipple-areolar complex (NAC) to the IMF, was set to 6 cm in all patients. Before the operation, a mixed solution of 0.5% lidocaine and 1:200,000 epinephrine in lactated Ringer’s solution was infiltrated along the incision line and in the area of estimated resection. In the fat and fatn groups, the fat grafts were harvested from the lateral border of the breast before starting the resection. Then, the pedicle was de-epithelialized and elevated from the chest wall. The resection was conducted according to the preoperative markings. The pedicle was rotated to the new location by exercising care to ensure that no undue tension or kinking was placed on the pedicle. The lateral and medial flaps were brought together in a tension-free manner to prevent delayed wound healing and the skin was closed in layers using 4/0 PDS and 5/0 Monocryl (Ethicon, New Brunswick, NJ) sutures. After the suturing procedure, fat and fatn grafts were injected under the entire surgical incision line subcutaneously by using a 23-G cannula into the fat and fatn groups, respectively (0.5 ml of fat or fatn graft injected for a 2-cm scar) (Figure 2).